trauma hepatico
TRANSCRIPT
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TRAUMA HEPATICO
PRESENTADO POR:MARIA YOLANDA GARCIA ARANGOINSTRUMENTACIÓN QUIRÚRGICA UNIBOYACA
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ANATOMIA
Glándula mas grande del cuerpo Hipocondrio derecho
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CAPSULA DE GLISSON
Es una capsula fibrosa que rodeacompletamente el higado, es resistente y delgada.CARA EXTERNA: Se adhiere al peritoneo CARA INTERNA: Envia tabiques conjuntivos entre
lobulillos y lobulos
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CARA DIAFRAGMATICA
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CARA VISCERAL
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MEDIOS DE FIJACIÓN
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IRRIGACIÓN
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VESICULA BILIAR
Fosa vesicular Cara inferior del higado entre los lobulos derecho y cuadrado por
lo general es extrahepatica Arteria Cistica Hepatica Derecha Medio de fijaciónPeritoneo
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MEDIOS DIAGNOSTICOS
PACIENTES INESTABLES LPD FAST
PACIENTES ESTABLES FAST TAC LAPAROSCOPIA DIAGNOSTICA
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Organo abdominal mas propenso a sufrir traumas, siendo el lobulo derecho el mas afectado en la mayoria de los casos
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GRADO IV
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GRADO V
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INSTRUMENTAL
Equipo general o de laparotomia Equipo Vascular Separador de Deavers Separador de Richardson
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ELEMENTOS E INSUMOS
Electrobsiturí Compresas Manilares Agentes hemostaticos Malla de poliglactina Adehesivo de fibrina Pinza de paquete
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SUTURAS
Prolene 2/0 ó 3/0 PS1Vicryl 1 ó 0 CT1Seda precortada 2/0Vicryl 3/0 SH
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TÉCNICA QUIRÚRGICA
AnestesiaAsepsia y antisepsiaVestida de pacienteIncision infraumbilicalInicialmente controlar la hemorragia
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MANIOBRA DE PRINGLE
• Ocluye la triada Portal a nivel del hiato Winslow.• Con pinza vascular apretando entre el pulgar y los
dedos anteriores las margenes del ligamento Hepatoduodenal
• Ocluye irrigacion sanguinea desde las art. Hepatica y V. Porta hacia el hígado
• Sangrado de la V. Cava inf y V. Hepatica no se detiene con esta maniobra
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Descrita en 1908 por J. Hogarth Pringle
Pinzamiento debe ser liberado cada
15-20 min
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MANIOBRAS HEMOSTATICAS PARA LESIONES SEVERAS
Empaquetamiento Hepatorrafia Fractura digital Selladores de Fibrina y dispositivos hemostaticos Reseccion Hepatica Ligadura de la arteria Hepatica
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